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PERMITTEE NAME: Mulletfs Excavating, L.L.C. ~~~+~~~~® <br />PERMIT NO.: M-2000-115 ~~~ 2 ~ 2~~ <br />OPERATION NAME: Mulletts Excavting Pit # 1 <br />ANNIVERSARY DATE: January 29, 2004 ~"'~ <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />_ shall submit the annual fee,_ a re ort a_nd map showine the extent of current~Ijsturbances to_affected land, - <br />-reclamation-accomplished-to-date-and during-the preceding year, new disturbances-that are-anticipated-to-occur- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written anneal renort and anneal reTort m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Myron Mullett <br />Permittee Name: Mullett's Excavating, L.L.C. <br />Address: P. O. Box 322 <br />Westcliffe, CO 81252-0322 <br />Phone Number: (719) 783-2056 <br />Fax Number: (719) 783-0156 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Si rora r, Owner, or Designee <br />Date <br />M:\PERMITUTASTERDOCUMENTSN4-AF-01 <br />